Canberra hospitals are trialling a toolkit (PREDICT: Prevention and Early Delirium Identification Carers Toolkit) to help carers and families of older people recognise symptoms of delirium — a sudden, temporary, and severe state of confusion often mistaken for dementia.

But whereas dementia is a long-term progressive degenerative illness that cannot be reversed or treated, delirium is a short-term illness that can be prevented and cured. 

Its onset might be hours to days, and it can be resolved in a day.

Untreated, however, it can last weeks or months; contribute to dementia or the risk of another episode of delirium; and even be fatal.

“We consider it a medical emergency, and it’s something we need to identify and treat,” PREDICT implementation nurse Liam Crossman said.

To that end, PREDICT is being rolled out in Canberra Hospital, North Canberra Hospital, and the University of Canberra Hospital, as well as in NSW and Queensland.

Available online, by smartphone, and on paper, the toolkit has eight information videos — 30 seconds long, and in plain English — and a checklist of seven yes/no questions: 

Does the patient know where they are? Can they focus properly? Are they drifting in and out of conversations? Do their answers to questions make sense? Are they acting irrationally, or being uncooperative? Are their eating, drinking, and movement impaired? 

If carers answer yes to four or more of those questions, they must tell the doctor or nurse they are concerned the patient might be suffering from delirium.

“A lot of carers I’ve spoken to about the tool have said: ‘I feel like we’ve had something like this happen to us before, but we didn’t know what to say,’” Mr Crossman said. “Now they feel they’ve been empowered, and they have more confidence to have those conversations with a clinician. It increases their knowledge and gets them involved with their loved ones’ care while they’re in hospital.”

Delirium is the second-most common hospital-acquired condition in Australia: more than half the patients admitted to hospital over 65 are at risk. It is a stress-response that can be caused by urinary tract infections or pneumonia, anaesthetic after surgery, undertreated pain, constipation, or disorienting changes in environment.

The symptoms are similar to dementia: confusion; agitation; difficulty focusing on a task or conversation; and seeing or hearing things that aren’t there.

“Classically,” Mr Crossman said, “we see a change in how the person is thinking or behaving.” 

Carers and family members can better recognise than medical practitioners if a patient’s behaviour has changed from when living in the community.

“Any visitor to the hospital is going to know that person in the bedspace better than what you do, which means they’re in a great position to be able to contribute to that person’s care and identify any risk and help us get the best outcome for their loved one,” Mr Crossman said.

Sometimes the changes are obvious to family members, Mr Crossman said. This week, a patient’s family member told him: ‘Yep, Dad kept pointing at the wall and saying there were spiders crawling about.’ There was a nail on the wall that clearly held something up at some point, and the patient kept identifying that as a spider.”

But sometimes the changes are subtle. “[Patients] can just become drowsier and sleepier, and [family members] think: ‘Oh, they’re just tired; they’re unwell; they’re in hospital — so we’re going to let them sleep.’ That’s actually a delirium that’s causing them to become quite sedated, which is dangerous, because then they stop eating and drinking; they’re not walking around; and it can lead to more illnesses as it progresses.”

The rollout in ACT hospitals is part of a three-year trial led by Professor Christine Aggar from Southern Cross University involving 2,500 patients in ACT, NSW and Queensland. The trial targets patients over 65, or Aboriginal and Torres Strait Islander people over 45. In this jurisdiction, University of Canberra has partnered with Southern Cross University to roll it out.

The trial began in March. The health service is now talking more about dementia, Mr Crossman observed.

“My background as a registered nurse is in our acute care of the elderly units. Delirium’s at the forefront of forefront of what we do every single day, so it’s always a focus. In other clinical areas, they have other clinical priorities to focus on, they’ve always got delirium in the back of their mind, but it’s not something they necessarily see every day. 

“By engaging with this tool, they’re talking about it more, and that’s really positive, because at the end of the day, there’s not one single clinician that’s responsible for good delirium care. Delirium is everybody’s business.”